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Bierbaum M, Rapport F, Arnolda G, Tran Y, Nic Giolla Easpaig B, Ludlow K, Clay-Williams R, Austin E, Laginha B, Lo CY, Churruca K, van Baar L, Hutchinson K, Chittajallu R, Owais SS, Nullwala R, Hibbert P, Fajardo Pulido D, Braithwaite J. Rates of adherence to cancer treatment guidelines in Australia and the factors associated with adherence: A systematic review. Asia Pac J Clin Oncol 2023; 19:618-644. [PMID: 36881529 DOI: 10.1111/ajco.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 03/08/2023]
Abstract
Adherence to cancer treatment clinical practice guidelines (CPGs) varies enormously across Australia, despite being associated with improved patient outcomes. This systematic review aims to characterize adherence rates to active-cancer treatment CPGs in Australia and related factors to inform future implementation strategies. Five databases were systematically searched, abstracts were screened for eligibility, a full-text review and critical appraisal of eligible studies performed, and data extracted. A narrative synthesis of factors associated with adherence was conducted, and the median adherence rates within cancer streams calculated. A total of 21,031 abstracts were identified. After duplicates were removed, abstracts screened, and full texts reviewed, 20 studies focused on adherence to active-cancer treatment CPGs were included. Overall adherence rates ranged from 29% to 100%. Receipt of guideline recommended treatments was higher for patients who were younger (diffuse large B-cell lymphoma [DLBCL], colorectal, lung, and breast cancer); female (breast and lung cancer), and male (DLBCL and colorectal cancer); never smokers (DLBCL and lung cancer); non-Indigenous Australians (cervical and lung cancer); with less advanced stage disease (colorectal, lung, and cervical cancer), without comorbidities (DLBCL, colorectal, and lung cancer); with good-excellent Eastern Cooperative Oncology Group performance status (lung cancer); living in moderately accessible places (colon cancer); and; treated in metropolitan facilities (DLBLC, breast and colon cancer). This review characterized active-cancer treatment CPG adherence rates and associated factors in Australia. Future targeted CPG implementation strategies should account for these factors, to redress unwarranted variation particularly in vulnerable populations, and improve patient outcomes (Prospero number: CRD42020222962).
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Brona Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Bela Laginha
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Chi Yhun Lo
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Lieke van Baar
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Renuka Chittajallu
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Riverina Cancer Care Centre, Wagga Wagga, New South Wales, Australia
- GenesisCare, Kingswood, New South Wales, Australia
| | - Syeda Somyyah Owais
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Ruqaiya Nullwala
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- North Eastern Public Health Unit, Eastern Health, Melbourne, Victoria, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
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Bierbaum M, Arnolda G, Braithwaite J, Rapport F. Clinician attitudes towards cancer treatment guidelines in Australia. BMC Res Notes 2023; 16:80. [PMID: 37194072 DOI: 10.1186/s13104-023-06356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES Clinical Practice Guidelines (CPGs) are designed to guide treatment decisions, yet adherence rates vary widely. To characterise perceived barriers and facilitators to cancer treatment CPG adherence in Australia, and estimate the frequency of previous qualitative research findings, a survey was distributed to Australian oncologists. RESULTS The sample is described and validated guideline attitude scores reported for different groups. Differences in mean CPG attitude scores across clinician subgroups and associations between frequency of CPG use and clinician characteristics were calculated; with 48 respondents there was limited statistical power to find differences. Younger oncologists (< 50 years) and clinicians participating in three or more Multidisciplinary Team Meetings were more likely to routinely or occasionally use CPGs. Perceived barriers and facilitators were identified. Thematic analysis was conducted on open-text responses. Results were integrated with previous interview findings and presented in a thematic, conceptual matrix. Most barriers and facilitators identified earlier were corroborated by survey results, with minor discordance. Identified barriers and facilitators require further exploration within a larger sample to assess their perceived impact on cancer treatment CPG adherence in Australia, as well as to inform future CPG implementation strategies. This research was Human Research Ethics Committee approved (2019/ETH11722 and 52019568810127, ID:5688).
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2113, Australia.
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2113, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2113, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2113, Australia
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Li S, Zhu X, Zhang L, Huang C, Li D. The effect of pain-education nursing based on a mind map on postoperative pain score and quality of life in patients with colorectal cancer. Medicine (Baltimore) 2023; 102:e33562. [PMID: 37171350 PMCID: PMC10174362 DOI: 10.1097/md.0000000000033562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Mind mapping is a combination of images and logical thinking in the form of pictures and texts. It presents a natural expression process that conforms to the divergent thinking of the brain, helping patients understand memory. This study aimed to investigate the impact of pain-education nursing with the aid of mind maps on postoperative pain scores and quality of life in patients with colorectal cancer. The medical records of 100 colorectal cancer patients treated from July 2020 to July 2022 were selected as retrospective research participants and divided into control and observation groups. The control group received routine pain care, and the observation group was given pain-education nursing based on a mind map. The effects on quality of life, pain, negative emotions, and comfort after nursing were compared between the 2 groups. There was no significant difference in quality of-life scores between the 2 groups before the nursing intervention (P > .05). After nursing, the physical, emotional, cognitive, and social functions of patients in the observation group were significantly higher than those in the control group. However, the overall quality of life and financial difficulties of patients in the observation group were significantly lower than those in the control group (P < .05). The observation group's social, physical, and psychological comfort scores were significantly higher than those in the control group after nursing intervention (P < .05). After nursing, the observation group's visual analog scale scores at different times after the operation were significantly lower than those of the control group. The scores on the self-rating anxiety scale and self-rating depression scale in the observation group were significantly lower than those in the control group (P < .05). Pain-education nursing based on mind maps can effectively improve the daily living ability, pain symptoms, and quality of life of patients after colorectal cancer, and there is a reference value for post-nursing care of patients after colorectal cancer.
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Affiliation(s)
- Shan Li
- Pain Department Hand Surgery, Wuhan Fourth Hospital, Wuhan, Hubei, China
| | - Xiaohong Zhu
- Department of Surgery, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi City, Hubei Province, China
| | - Lihua Zhang
- Pain Department Hand Surgery, Wuhan Fourth Hospital, Wuhan, Hubei, China
| | - Cui Huang
- Urology Gastrointestinal Surgery, Wuhan Fourth Hospital, Wuhan Fourth Hospital, Wuhan, Hubei, China
| | - Dan Li
- Urology Gastrointestinal Surgery, Wuhan Fourth Hospital, Wuhan Fourth Hospital, Wuhan, Hubei, China
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Yap S, He E, Egger S, Goldsbury DE, Lew JB, Ngo PJ, Worthington J, Rillstone H, Zalcberg JR, Cuff J, Ward RL, Canfell K, Feletto E, Steinberg J. Colon and rectal cancer treatment patterns and their associations with clinical, sociodemographic and lifestyle characteristics: analysis of the Australian 45 and Up Study cohort. BMC Cancer 2023; 23:60. [PMID: 36650482 PMCID: PMC9845101 DOI: 10.1186/s12885-023-10528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Colorectal cancer is the third most diagnosed cancer globally and the second leading cause of cancer death. We examined colon and rectal cancer treatment patterns in Australia. METHODS From cancer registry records, we identified 1,236 and 542 people with incident colon and rectal cancer, respectively, diagnosed during 2006-2013 in the 45 and Up Study cohort (267,357 participants). Cancer treatment and deaths were determined via linkage to routinely collected data, including hospital and medical services records. For colon cancer, we examined treatment categories of "surgery only", "surgery plus chemotherapy", "other treatment" (i.e. other combinations of surgery/chemotherapy/radiotherapy), "no record of cancer-related treatment, died"; and, for rectal cancer, "surgery only", "surgery plus chemotherapy and/or radiotherapy", "other treatment", and "no record of cancer-related treatment, died". We analysed survival, time to first treatment, and characteristics associated with treatment receipt using competing risks regression. RESULTS 86.4% and 86.5% of people with colon and rectal cancer, respectively, had a record of receiving any treatment ≤2 years post-diagnosis. Of those treated, 93.2% and 90.8% started treatment ≤2 months post-diagnosis, respectively. Characteristics significantly associated with treatment receipt were similar for colon and rectal cancer, with strongest associations for spread of disease and age at diagnosis (p<0.003). For colon cancer, the rate of "no record of cancer-related treatment, died" was higher for people with distant spread of disease (versus localised, subdistribution hazard ratio (SHR)=13.6, 95% confidence interval (CI):5.5-33.9), age ≥75 years (versus age 45-74, SHR=3.6, 95%CI:1.8-7.1), and visiting an emergency department ≤1 month pre-diagnosis (SHR=2.9, 95%CI:1.6-5.2). For rectal cancer, the rate of "surgery plus chemotherapy and/or radiotherapy" was higher for people with regional spread of disease (versus localised, SHR=5.2, 95%CI:3.6-7.7) and lower for people with poorer physical functioning (SHR=0.5, 95%CI:0.3-0.8) or no private health insurance (SHR=0.7, 95%CI:0.5-0.9). CONCLUSION Before the COVID-19 pandemic, most people with colon or rectal cancer received treatment ≤2 months post-diagnosis, however, treatment patterns varied by spread of disease and age. This work can be used to inform future healthcare requirements, to estimate the impact of cancer control interventions to improve prevention and early diagnosis, and serve as a benchmark to assess treatment delays/disruptions during the pandemic. Future work should examine associations with clinical factors (e.g. performance status at diagnosis) and interdependencies between characteristics such as age, comorbidities, and emergency department visits.
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Affiliation(s)
- Sarsha Yap
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Emily He
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Sam Egger
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - David E Goldsbury
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Jie-Bin Lew
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Preston J Ngo
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Joachim Worthington
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Hannah Rillstone
- grid.420082.c0000 0001 2166 6280Cancer Policy and Advocacy, Cancer Council NSW, Woolloomooloo, Sydney, New South Wales Australia
| | - John R Zalcberg
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia ,grid.267362.40000 0004 0432 5259Department of Medical Oncology, Alfred Health, Melbourne, Victoria Australia
| | - Jeff Cuff
- grid.1005.40000 0004 4902 0432Faculty of Science Biotech and Biomolecular Science, University of New South Wales, Sydney, New South Wales Australia ,Research Advocate, The Daffodil Centre, Sydney, New South Wales Australia
| | - Robyn L Ward
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales Australia
| | - Karen Canfell
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Eleonora Feletto
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
| | - Julia Steinberg
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, New South Wales 2011 Australia
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Voigt W, Trautwein M. Improved guideline adherence in oncology through clinical decision-support systems: still hindered by current health IT infrastructures? Curr Opin Oncol 2023; 35:68-77. [PMID: 36367223 DOI: 10.1097/cco.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE OF REVIEW Despite several efforts to enhance guideline adherence in cancer management, the rate of adherence remains often dissatisfactory in clinical routine. Clinical decision-support systems (CDSS) have been developed to support the management of cancer patients by providing evidence-based recommendations. In this review, we focus on both current evidence supporting the beneficial effects of CDSS on guideline adherence as well as technical and structural requirements for CDSS implementation in clinical routine. RECENT FINDINGS Some studies have demonstrated a significant improvement of guideline adherence by CDSSs in oncologic diseases such as breast cancer, colon cancer, cervical cancer, prostate cancer, and hepatocellular carcinoma as well as in the management of cancer pain. However, most of these studies were rather small and designs rather simple. One reason for this limited evidence might be that CDSSs are only occasionally implemented in clinical routine. The main limitations for a broader implementation might lie in the currently existing clinical data infrastructures that do not sufficiently allow CDSS interoperability as well as in some CDSS tools themselves, if handling is hampered by poor usability. SUMMARY In principle, CDSSs improve guideline adherence in clinical cancer management. However, there are some technical und structural obstacles to overcome to fully implement CDSSs in clinical routine.
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Affiliation(s)
- Wieland Voigt
- Wieland Voigt, Medical Innovations and Management, Steinbeis University Berlin, Berlin
| | - Martin Trautwein
- Martin Trautwein, Senior Medical Advisor, Cognostics GmbH, Munich, Germany
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Bierbaum M, Rapport F, Arnolda G, Delaney GP, Liauw W, Olver I, Braithwaite J. Clinical practice guideline adherence in oncology: A qualitative study of insights from clinicians in Australia. PLoS One 2022; 17:e0279116. [PMID: 36525435 PMCID: PMC9757567 DOI: 10.1371/journal.pone.0279116] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The burden of cancer is large in Australia, and rates of cancer Clinical Practice Guideline (CPG) adherence is suboptimal across various cancers. METHODS The objective of this study is to characterise clinician-perceived barriers and facilitators to cancer CPG adherence in Australia. Semi-structured interviews were conducted to collect data from 33 oncology-focused clinicians (surgeons, radiation oncologists, medical oncologists and haematologists). Clinicians were recruited in 2019 and 2020 through purposive and snowball sampling from 7 hospitals across Sydney, Australia, and interviewed either face-to-face in hospitals or by phone. Audio recordings were transcribed verbatim, and qualitative thematic analysis of the interview data was undertaken. Human research ethics committee approval and governance approval was granted (2019/ETH11722, #52019568810127). RESULTS Five broad themes and subthemes of key barriers and facilitators to cancer treatment CPG adherence were identified: Theme 1: CPG content; Theme 2: Individual clinician and patient factors; Theme 3: Access to, awareness of and availability of CPGs; Theme 4: Organisational and cultural factors; and Theme 5: Development and implementation factors. The most frequently reported barriers to adherence were CPGs not catering for patient complexities, being slow to be updated, patient treatment preferences, geographical challenges for patients who travel large distances to access cancer services and limited funding of CPG recommended drugs. The most frequently reported facilitators to adherence were easy accessibility, peer review, multidisciplinary engagement or MDT attendance, and transparent CPG development by trusted, multidisciplinary experts. CPGs provide a reassuring framework for clinicians to check their treatment plans against. Clinicians want cancer CPGs to be frequently updated utilising a wiki-like process, and easily accessible online via a comprehensive database, coordinated by a well-trusted development body. CONCLUSION Future implementation strategies of cancer CPGs in Australia should be tailored to consider these context-specific barriers and facilitators, taking into account both the content of CPGs and the communication of that content. The establishment of a centralised, comprehensive, online database, with living wiki-style cancer CPGs, coordinated by a well-funded development body, along with incorporation of recommendations into point-of-care decision support would potentially address many of the issues identified.
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- * E-mail:
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
| | - Geoff P. Delaney
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SWSLHD Cancer Services, Liverpool, Australia
| | - Winston Liauw
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
- SESLHD Cancer Service, Kogarah, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Sydney, Australia
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Bierbaum M, Rapport F, Arnolda G, Tran Y, Nic Giolla Easpaig B, Ludlow K, Braithwaite J. Adherence to clinical practice guidelines (CPGs) for the treatment of cancers in Australia and the factors associated with adherence: a systematic review protocol. BMJ Open 2021; 11:e050912. [PMID: 34548359 PMCID: PMC8458325 DOI: 10.1136/bmjopen-2021-050912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Clinical practice guidelines (CPGs) synthesise the latest evidence to support clinical and patient decision-making. CPG adherent care is associated with improved patient survival outcomes; however, adherence rates are low across some cancer streams in Australia. Greater understanding of specific barriers to cancer treatment CPG adherence is warranted to inform future implementation strategies.This paper presents the protocol for a systematic review that aims to determine cancer treatment CPG adherence rates in Australia across a variety of common cancers, and to identify any factors associated with adherence to those CPGs, as well as any associations between CPG adherence and patient outcomes. METHODS AND ANALYSIS Five databases will be searched, Ovid Medline, PsychInfo, Embase, Scopus and Web of Science, for eligible studies evaluating adherence rates to cancer treatment CPGs in Australia. A team of reviewers will screen the abstracts in pairs according to predetermined inclusion criteria and then review the full text of eligible studies. All included studies will be assessed for quality and risk of bias. Data will be extracted using a predefined data extraction template. The frequency or rate of adherence to CPGs, factors associated with adherence to those CPGs and any reported patient outcome rates (eg, relative risk ratios or 5-year survival rates) associated with adherence to CPGs will be described. If applicable, a pooled estimate of the rate of adherence will be calculated by conducting a random-effects meta-analysis. The systematic review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ETHICS AND DISSEMINATION Ethics approval will not be required, as this review will present anonymised data from other published studies. Results from this study will form part of a doctoral dissertation (MB), will be published in a journal, presented at conferences, and other academic presentations. PROSPERO REGISTRATION NUMBER CRD42020222962.
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Macquarie University Hearing, Sydney, New South Wales, Australia
| | - Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kristiana Ludlow
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- The University of Queensland, School of Psychology, Saint Lucia, Queensland, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Scheepers ERM, Schiphorst AH, van Huis-Tanja LH, Emmelot-Vonk MH, Hamaker ME. Treatment patterns and primary reasons for adjusted treatment in older and younger patients with stage II or III colorectal cancer. Eur J Surg Oncol 2021; 47:1675-1682. [PMID: 33563486 DOI: 10.1016/j.ejso.2021.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/10/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE This study aims to assess age-related treatment patterns and primary reasons for adjusted treatment in patients with colorectal cancer. METHODS Patients with colorectal cancer stage II or III diagnosed between 2015 and 2018 in the Netherlands were eligible for this study. Data were provided by the Netherlands Cancer Registry and included socio-demographics, clinical characteristics, treatment patterns and primary reasons for adjusted treatment. Treatment patterns and reasons for adjusted treatment were analysed according to age groups. RESULTS Of all 29,620 patients, 30% were aged <65 years (n = 8994), 34% between 65 and 75 years (n = 10,173), 27% between 75 and 85 years (n = 8102) and 8% were ≥85 years (n = 2349). Irrespective of cancer location or stage, older patients received less frequently a combination of surgery and (neo)adjuvant therapy compared to younger patients (decreasing from 55% to 1% in colon cancer patients, and from 71% to 23% in rectal cancer patients aged <65 years and ≥85 years respectively). Omission of surgical treatment increased with age in both patients with colon cancer (ranging from 1% in patients aged <65 years to 16% in those ≥85 years) and rectal cancer (ranging from 12% in patients aged <65 years to 56% in those ≥85 years). The most common reasons for adjusted treatment were patient preference (27%) and functional status (20%), both reasons increased with advancing age. CONCLUSIONS Guideline non-adherence increased with advancing age and omission of standard treatment was mainly based on patient preference and functional status. These findings provides insight in the treatment decision-making process in patients with colorectal cancer. Future research is necessary to further assess patient's role in the treatment decision-making process.
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Affiliation(s)
- E R M Scheepers
- Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands.
| | - A H Schiphorst
- Department of Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - L H van Huis-Tanja
- Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | - M H Emmelot-Vonk
- Department of Geriatric Medicine, University Medical Centre Utrecht, the Netherlands
| | - M E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht, the Netherlands
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Aguiar Junior S, Oliveira MMD, Silva DRME, Mello CALD, Calsavara VF, Curado MP. SURVIVAL OF PATIENTS WITH COLORECTAL CANCER IN A CANCER CENTER. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:172-177. [PMID: 33206858 DOI: 10.1590/s0004-2803.202000000-32] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/27/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hospital-based studies recently have shown increases in colorectal cancer survival, and better survival for women, young people, and patients diagnosed at an early disease stage. OBJECTIVE To describe the overall survival and analyze the prognostic factors of patients treated for colorectal cancer at an oncology center. METHODS The analysis included patients diagnosed with colon and rectal adenocarcinoma between 2000 and 2013 and identified in the Hospital Cancer Registry at A.C.Camargo Cancer Center. Overall 5-year survival was estimated using the Kaplan-Meier method, and prognostic factors were evaluated in a Cox regression model. Hazard ratios (HR) are reported with 95% confidence intervals (CI). RESULTS Of 2,279 colorectal cancer cases analyzed, 58.4% were in the colon. The 5-year overall survival rate for colorectal cancer patients was 63.5% (65.6% and 60.6% for colonic and rectal malignancies, respectively). The risk of death was elevated for patients in the 50-74-year (HR=1.24, 95%CI =1.02-1.51) and ≥75-year (HR=3.02, 95%CI =2.42-3.78) age groups, for patients with rectal cancer (HR=1.37, 95%CI =1.11-1.69) and for those whose treatment was started >60 days after diagnosis (HR=1.22, 95%CI =1.04-1.43). The risk decreased for patients diagnosed in recent time periods (2005-2009 HR=0.76, 95%CI =0.63-0.91; 2010-2013 HR=0.69, 95%CI =0.57-0.83). CONCLUSION Better survival of patients with colorectal cancer improves with early stage and started treatment within 60 days of diagnosis. Age over 70 years old was an independent factor predictive of a poor prognosis. The overall survival increased to all patients treated in the period 2000-2004 to 2010-2013.
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Affiliation(s)
- Samuel Aguiar Junior
- Departamento de Cirurgia Pélvica, A.C.Camargo Cancer Center, São Paulo, SP, Brasil
| | - Max Moura de Oliveira
- Grupo de Epidemiologia e Estatística em Câncer, Centro Internacional de Pesquisa, A.C.Camargo Cancer Center, São Paulo, SP, Brasil
| | - Diego Rodrigues Mendonça E Silva
- Grupo de Epidemiologia e Estatística em Câncer, Centro Internacional de Pesquisa, A.C.Camargo Cancer Center, São Paulo, SP, Brasil
| | | | - Vinicius Fernando Calsavara
- Grupo de Epidemiologia e Estatística em Câncer, Centro Internacional de Pesquisa, A.C.Camargo Cancer Center, São Paulo, SP, Brasil
| | - Maria Paula Curado
- Grupo de Epidemiologia e Estatística em Câncer, Centro Internacional de Pesquisa, A.C.Camargo Cancer Center, São Paulo, SP, Brasil
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10
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A systematic scoping review of determinants of multidisciplinary cancer team access and decision-making in the management of older patients diagnosed with colorectal cancer. J Geriatr Oncol 2020; 11:909-916. [DOI: 10.1016/j.jgo.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/06/2019] [Accepted: 11/04/2019] [Indexed: 12/24/2022]
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11
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Bierbaum M, Rapport F, Arnolda G, Nic Giolla Easpaig B, Lamprell K, Hutchinson K, Delaney GP, Liauw W, Kefford R, Olver I, Braithwaite J. Clinicians' attitudes and perceived barriers and facilitators to cancer treatment clinical practice guideline adherence: a systematic review of qualitative and quantitative literature. Implement Sci 2020; 15:39. [PMID: 32460797 PMCID: PMC7251711 DOI: 10.1186/s13012-020-00991-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background Clinical Practice Guidelines (CPGs) synthesize the best available evidence to guide clinician and patient decision making. There are a multitude of barriers and facilitators to clinicians adhering to CPGs; however, little is known about active cancer treatment CPG adherence specifically. This systematic review sought to identify clinician attitudes, and perceived barriers and facilitators to active cancer treatment CPG adherence. Methods A systematic search was undertaken of five databases; Ovid Medline, PsychInfo, Embase, Scopus, CINAHL, and PROQUEST. The retrieved abstracts were screened for eligibility against inclusion criteria, and a full text review was conducted of all eligible studies. Data were extracted, and a quality assessment was conducted of all included studies. The qualitative papers were thematically analyzed. Attitudes, barriers, and facilitating factors extracted from the quantitative papers were categorized within the qualitative thematic framework. Results The search resulted in the identification of 9676 titles. After duplicates were removed, abstracts screened, and full texts reviewed, 15 studies were included. Four themes were identified which related to negative clinician attitudes and barriers to active cancer treatment CPG adherence: (1) concern over CPG content and currency of CPGs; (2) concern about the evidence underpinning CPGs; (3) clinician uncertainty and negative perceptions of CPGs; and (4) organizational and patient factors. The review also identified four themes related to positive attitudes and facilitators to active cancer treatment CPG adherence: (5) CPG accessibility and ease of use; (6) endorsement and dissemination of CPGs and adequate access to treatment facilities and resources; (7) awareness of CPGs and belief in their relevance; and (8) belief that CPGs support decision making, improve patient care, reduce clinical variation, and reduce costs. Conclusion These results highlight that adherence to active cancer treatment CPG recommendations by oncology clinicians is influenced by multiple factors such as attitudes, practices, and access to resources. The review has also revealed many similarities and differences in the factors associated with general CPG, and active cancer treatment CPG, adherence. These findings will inform tailored implementation strategies to increase adherence to cancer treatment CPGs. Trial registration PROSPERO (2019) CRD42019125748.
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia.
| | - Frances Rapport
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia.,Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Brona Nic Giolla Easpaig
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia.,Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Klay Lamprell
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia.,Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia
| | - Geoff P Delaney
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia.,Cancer Services, South Western Sydney Local Health District Cancer Services, Sydney, Australia.,University of NSW, Sydney, Australia.,Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Winston Liauw
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia.,University of NSW, Sydney, Australia.,South Eastern Sydney Local Health District Cancer Services, Kogarah, Australia
| | - Richard Kefford
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia.,Department of Clinical Medicine, Macquarie University, Sydney, Australia
| | - Ian Olver
- Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia.,University of Adelaide, Adelaide, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation (AIHI), Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2019, Australia.,Centre for Research Excellence in Implementation Science in Oncology, AIHI, Macquarie University, Sydney, Australia
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12
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Bierbaum M, Braithwaite J, Arnolda G, Delaney GP, Liauw W, Kefford R, Tran Y, Nic Giolla Easpaig B, Rapport F. Clinicians' attitudes to oncology clinical practice guidelines and the barriers and facilitators to adherence: a mixed methods study protocol. BMJ Open 2020; 10:e035448. [PMID: 32205377 PMCID: PMC7103843 DOI: 10.1136/bmjopen-2019-035448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/27/2020] [Accepted: 03/03/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Clinical practice guidelines (CPGs) are designed to reduce inappropriate clinical variation and improve the quality of care. Barriers to CPGs include a lack of awareness of CPGs, access to them, time pressures and concerns regarding the evidence underpinning CPG development, implementation and dissemination. The objectives of this study are to assess clinicians' attitudes to CPGs for cancer treatment and the perceived barriers to and facilitators of CPG adherence in order to inform the implementation of cancer treatment CPGs. METHODS AND ANALYSIS A mixed methods study will be conducted using a three-phase, sequential design, with each phase informing the next. In phase 1, a qualitative study using recorded interviews will investigate clinicians' attitudes to CPGs for cancer treatment and perceptions of barriers and facilitators to CPG adherence (n=30); interview transcripts will be analysed thematically. In phase 2, a survey will quantify the frequency of attitudes, barriers and facilitators identified in phase 1, in a broader clinical sample (n=200). In phase 3, a workshop forum will be held to facilitate discussions examining the implications of phase 1 and 2 findings for cancer CPG implementation strategies (n=40) leading to recommendations for improvements to practice. The workshop discussion will be recorded, and the transcript will be analysed thematically. ETHICS AND DISSEMINATION This study has received ethics approval in New South Wales, Australia (2019/ETH11722, #52019568810127). Study findings will be published in peer-reviewed journals and will form part of a doctoral thesis and be presented at national and international conferences.
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Geoffrey P Delaney
- Centre for Research Excellence in Implementation Science in Oncology, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
- University of New South Wales South Western Sydney Clinical School, Liverpool, New South Wales, Australia
| | - Winston Liauw
- Centre for Research Excellence in Implementation Science in Oncology, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Translational Cancer Research Network, Lowy Cancer Research Centre, University of New South Wales, Sydney, New South Wales, Australia
- Cancer Services, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia
| | - Richard Kefford
- Centre for Research Excellence in Implementation Science in Oncology, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Department of Clinical Medicine, Macquarie University, Sydney, New South Wales, Australia
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Bróna Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Centre for Research Excellence in Implementation Science in Oncology, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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13
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Liu X, Cui Y, Zhang Y, Liu Z, Zhang Q, Wu W, Zheng Z, Li S, Zhang Z, Li Y. A comprehensive study of immunology repertoires in both preoperative stage and postoperative stage in patients with colorectal cancer. Mol Genet Genomic Med 2019; 7:e504. [PMID: 30628178 PMCID: PMC6418368 DOI: 10.1002/mgg3.504] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/25/2018] [Accepted: 10/05/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the 3rd most common cancer type in the world. The correlation between immune repertoire and prognosis of CRC has been well studied in the last decades. The diversity and stability of the immune cells can be measured by hypervariable complementarity-determining region 3 (CDR3) segments of the T-cell receptor (TCR). METHODS In this study, we collected five healthy controls and 19 CRC patients' peripheral blood mononuclear cells (PBMCs) in three stages, namely 1 day preoperative, 3 days' postoperative, and 7 days' postoperative, respectively. Simultaneously, we have also done the comparative analysis of these two different anesthesia methods, namely TIVA and CEGA. Sequencing of the TCR segments has been performed by multiplex PCR and high-throughput next-generation sequencing. We also analyzed the distribution of CDR3 length, highly expansion clones (HECs), TRBV, and TRBJ gene usage. RESULTS Our result showed a significant difference between TCR CDR3 length distribution and HEC distribution between CRC patients and healthy controls. We also found that TRBV11-2, TRBV12-1, TRBV16, TRBV3-2, TRBV4-2, TRBV4-3, TRBV5-4, TRBV6-8, TRBV7-8, TRBV7-9 and RBV11-2, TRBV12-1, TRBV16, TRBV3-2, TRBV4-2, TRBV4-3, TRBV5-4, TRBV6-8, TRBV7-8, and TRBV7-9 usages are different between CRC patients and healthy controls. CONCLUSION In conclusion, CRC patients were presented with different immune repertoire in comparison with healthy controls. In this study, significant difference in TRBV and TRBJ gene usage in between case and control group could provide some potential biomarker for the diagnosis and the treatment of the patients with CRC.
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Affiliation(s)
- Xicheng Liu
- Department of Anesthesiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Yuanyuan Cui
- Department of Anesthesiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Yaoxian Zhang
- Department of Anesthesiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Zhanli Liu
- Department of Anesthesiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Qiuli Zhang
- Department of Anesthesiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Wenyan Wu
- Department of Anesthesiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Zihao Zheng
- Department of Anesthesiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Shien Li
- Department of Anesthesiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Zhongjun Zhang
- Department of Anesthesiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
| | - Yali Li
- Department of Anesthesiology, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
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